The Threat of Fentanyl‐Based Counterfeits in Mexican Pharmacies: Addressing a Growing Public Health Crisis

Pharmacists are perceived as protectors of public health, advancing trust in pharmacies and the drugs provided. However, this trust is often misplaced in Mexico, where pharmacists frequently dispense dangerous fentanyl‐based counterfeits without prescription orders and on‐demand. The convergence of four trends occurring in Mexico—the influx of international tourists seeking pharmaceuticals without prescription orders, increased domestic consumption of illicit fentanyl, expanded domestic production of illicit fentanyl, and the rise of fentanyl‐based counterfeits in Mexican pharmacies—has created a substantial risk to regional public health. Mexican cartels manufacture and distribute these counterfeit drugs, facilitated by corrupt officials engaged in limited drug enforcement. To address this emerging public health crisis, an independent fentanyl enforcement division should be established in Mexico to oversee expanded drug enforcement operations targeting cartels and their intermediaries. This division should conduct rigorous and surprise inspections of pharmacies accompanied by international observers and provide anonymous whistleblower channels for pharmacists and the public. Pharmacy owners found knowingly selling fentanyl‐based counterfeits should face severe penalties, including forfeiture of pharmacy licences, lifetime bans from owning and operating pharmacies, significant fines, and incarceration. By enacting these enforcement and public health reforms, Mexico can more effectively minimize the dispensation of fentanyl‐based counterfeits and safeguard regional public health.